ObjectiveDrug adherence is crucial to the success of highly active antiretroviral therapy (HAART) in the treatment of HIV disease. Adherence to HAART and its determinants may, however, differ across HIV/AIDS populations. MethodsWe retrospectively studied drug adherence by self-report in HIV-1 infected Chinese patients who have been on HAART for at least 1 year as at the end of year 2000. HAART is de®ned as three or more antiretrovirals with at least one protease inhibitor or non-nucleoside analogue reverse transcriptase inhibitor. ResultsThe last drug adherence level assessed by self-report in 161 Chinese patients were: grade A (100%) ± 130, 80.7%; grade B (95±99%) ± 25, 15.5%; grade C (90±94%) ± three, 1.9% and grade D (< 90%) ± three, 1.9%. Patients with full adherence were more likely to have undetectable (< 500 copies/mL) plasma virus level (adjusted OR, 4.22; 95% CI, 1.75±12.33). Patients' demographics, HIV disease status and antiretroviral regimen did not affect adherence. Partial drug adherence was, however, independently associated with the psychosocial factors of missing clinic appointments (adjusted OR, 3.13; 95% CI, 1.23±8.33), forgetfulness (adjusted OR, 4.55; 95% CI, 1.64±12.5) and a busy work life (adjusted OR, 6.67; 95% CI, 1.75±25). ConclusionThere were similarities and differences in determinants affecting HAART adherence in Chinese compared with other patients. Psychosocial factors rather than HIV disease or treatment were more important factors in our Chinese patients. The relevance of patient populations and care setting for adherence to HAART shall be further studied. IntroductionMorbidity and mortality among patients with HIV infection has declined with the advent of highly active antiretroviral therapy (HAART) [1,2]. To have maximal suppression of plasma virus load beyond detection limit is the laboratory target for gauging success of HAART. However, factors such as prior exposure to antiretrovirals [3], advanced HIV disease [4] and suboptimal drug adherence [5] were shown to affect the likelihood of prolonged virus suppression. Furthermore, since antiretroviral therapy is a long-term treatment, and not without side effects, maintaining a high level of drug adherence often represents a big challenge for both the patient and healthcare provider [6]. To maximally substantiate the bene®ts of HAART, measures to continually monitor and enhance patients' drug adherence has become indispensable for effective HIV management nowadays [7].Unfortunately, availability of HAART for treating HIV/AIDS patients has so far been largely limited to the developed Western countries. Hence, most studies on drug adherence to HAART had originated from these countries. A variety of factors has been found to predict antiretroviral MethodsThis was a retrospective study conducted at one of the largest HIV clinical services in Hong Kong ± the Integrated Treatment Centre of the Department of Health. In early 1997, shortly after the availability of HAART in our clinic, we commenced a drug adherence counselling program...

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Kaposi's Disease or Kaposi's Sarcoma (SK) is a multifocal malignant proliferation induced by viral growth factors, including interleukin 6 of human herpes virus type 8 (HHV8). We describe four forms of this disease who poses a real public health problem in East and Central Africa. The purpose of our observation was to report a rare condition in a Senegalese HIV-positive child. It was an 11-year-old girl from a region in central Senegal. She was an orphan of both parents, tested and monitored since the age of 5 for HIV infection 1. She was on the 1st line protocol. Due to a lack of support and good observance, she was referred to us at the age of 11 for follow-up in our structure in the suburbs of Dakar. The initial follow-up assessment showed a very low CD4 count and a very high viral load. Before the lack of clinical and immune-virological response, a genotypic resistance test was performed and showed immunological and virological failure. The initial development was marked by the appearance of lesions which were highly suggestive of Kaposi's disease. She was on 2nd line treatment. The histopathological aspect of cutaneous biopsy was very suggestive of Kaposi's disease. The subsequent course after ART and bleomycin treatment was clinically marked by regression of skin lesions. Virologically, it was marked by a fall in the viral load. Immunologically there was a gradual recovery of CD4 levels which came back to normal. Our observation demonstrates that absence of effective antiretroviral therapy for HIV increases the risk to develop Kaposi's sarcoma.